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North Carolina rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$793.33 / $5,611.88 / $7,993.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.21 / $900.35 / $1,672.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.79 / $1,024.55 / $1,974.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$774.63 / $1,025.04 / $1,987.89
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.07 / $972.38 / $1,388.33
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.00 / $606.00 / $1,119.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,728.00 / $3,733.00 / $6,543.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$740.45 / $908.37 / $2,135.44
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,489.16 / $5,489.16 / $26,542.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,798.24 / $6,747.84 / $7,852.73